Table 3.
Participant-Identified Barriers and Facilitators for Three Stages of HIV Treatment: Getting Tested for HIV, Entry into Care for HIV, and Engagement in HIV Care
|
Getting tested for HIV | ||
|---|---|---|
| Facilitators | Barriers | |
| Patient-level | • Already sick and scared | • Personal ignorance of risk factors / behavioral risk |
| • Pregnant–not wanting to infect fetus | • Drug addiction | |
| • Partner/drug-partner testing | • Don't really want to know | |
| • Partner tested positive | • Fear and stigma | |
| • Getting paid to be tested | ||
| Provider-level | • Good relationship with doctor | • No barriers identified because no pre-existing relationship with doctor |
| • Should include testing in annual exam | ||
| Clinic-level | • Counseling to let woman know she is competent to care for self | • Didn't choose to get tested; tested while incapacitated in health care setting |
| • Testing should be part of annual care | ||
| Community-level | • Communal awareness of HIV seriousness and risk factors | • Testing facility not discreet |
| • Testing availability | ||
| • Prison testing | ||
| Entry into HIV care/early care | ||
| Patient-level | • Know it is the right thing to do | • Drug addiction |
| • Want to get educated | • Fatalism; depression / trauma | |
| • Family / good friends support | • Adverse medication reactions | |
| • Want to stay healthy, general | • Shame, guilt, embarrassment | |
| • Want to stay healthy for children | • Family does not know | |
| Provider-level | • Caseworker/counselor support Positive provider attention • Taken care of by hospital coworkers | • No HIV education provided by MD • Having to change to HIV doctor • Being “lectured” to by doctor |
| Clinic-level | • Positive clinic attributes | • Lack of privacy / clinic not discreet |
| • Someone with you at diagnosis | • Travel inconvenient | |
| • Someone guide you through process | • Many complicated steps to get into care | |
| • Clinic in discreet location | ||
| • Help paying for medicine / services | ||
| • Specialized programs for women | ||
| Community-level | • Prison—supportive environment for diagnosis and treatment | • Community-level stigma |
| • Support groups / group home | ||
| Engagement in care | ||
| Patient-level | • Knowledge that HIV care works | • Appointment system failed |
| • Knowing not going to die | • Medicine makes sick/feel ill | |
| • Personal system for keeping appointments | • Sick; didn't feel like coming in | |
| • Family support | • Other family responsibilities | |
| • Getting off/staying off drugs | • Addiction; hopelessness; depression | |
| • Faith/religion | • Other medical needs trumped HIV care | |
| • Becoming familiar with routine care | • Felt too good to come in | |
| • Missed last appointment; personal sense needed to come to this one | • God taking care of health | |
| • Dislike blood work | ||
| • Personal forgetfulness | ||
| Provider-level | • Positive relationship with provider | • No barriers identified |
| • Positive relationship with clinic staff | ||
| Clinic-level | • Clinic conveniently located | • No clinic-provided reminder |
| • Clinic co-located with other services | • Clinic changed appointment time | |
| • Clinic provides reminders | • Appointment at inconvenient time | |
| • Support groups / therapy | • No child care | |
| Community-level | • Caseworker support • Had help with transportation | • Lack of transportation; transportation very inconvenient; no money for gas |
| • Bad weather | ||
Bold text indicates three or more women spontaneously offered same factor.